Robot-assisted kidney transplantation with regional hypothermia using grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: results from the European Association of Urology Robotic Urology Section Working Group

Background: Kidney transplantation using grafts with multiple vessels (GMVs) is technically demanding and may be associated with increased risk of complications or suboptimal graft function. To date, no studies have reported on robot-assisted kidney transplantation (RAKT) using GMVs. Objective: To report our experience with RAKT using GMVs from living donors, focusing on technical feasibility and early postoperative outcomes. Design, setting, and participants: We reviewed the multi-institutional, prospectively collected European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT database to select consecutive patients undergoing RAKT from living donors using GMVs between July 2015 and January 2018. Patients undergoing RAKT using grafts with single vessels (GSVs) served as controls. In case of GMVs, ex vivo vascular reconstruction techniques were performed during bench surgery according to the case-specific anatomy. Intervention: RAKT with regional hypothermia. Outcome measurements and statistical analysis: Intraoperative outcomes and early (30 d) postoperative complications and functional results were the main study endpoints. Multivariable logistic regression analysis evaluated potential predictors of suboptimal renal function at 1 mo. Results and limitations: Overall, 148 RAKTs were performed during the study period. Of these, 21/148 (14.2%) used GMVs; in all cases, single arterial and venous anastomoses could be performed after vascular reconstruction. Median anastomoses and rewarming times did not differ significantly between the GMV and GSV groups. Total and cold ischemia times were significantly higher in the GMV cohort (112 vs 88 min, p = 0.004 and 50 vs 34 min, p = 0.003, respectively). Overall complication rate and early functional outcomes were similar among the two groups. No major intra-or postoperative complications were recorded in the GMV cohort. At multivariable analysis, use of GMVs was not significantly associated with suboptimal renal function at 1 mo. Small sample size and short follow-up represent the main study limitations. Conclusions: RAKT using GMVs from living donors is technically feasible and achieved favorable perioperative and short-term functional outcomes. Larger studies with longer follow-up are needed to confirm our findings. Patient summary: In this study, we evaluated for the first time in literature the results of RAKT from living donors using kidneys with multiple arteries and veins. We found that, in experienced centers, RAKT using kidneys with multiple vessels is feasible and achieves optimal results in terms of postoperative kidney function with a low number of postoperative complications. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved

Standardized Duplex Ultrasound-Based Protocol for Early Diagnosis of Transplant Renal Artery Stenosis: Results of a Single-Institution Retrospective Cohort Study

Transplant renal artery stenosis (TRAS) is the most frequent vascular complication after kidney transplantation (KT) and has been associated with potentially reversible refractory hypertension, graft dysfunction, and reduced patient survival. The aim of the study is to describe the outcomes of a standardized Duplex Ultrasound- (DU-) based screening protocol for early diagnosis of TRAS and for selection of patients potentially requiring endovascular intervention. We retrospectively reviewed our prospectively collected database of KT from January 1998 to select patients diagnosed with TRAS. The follow-up protocol was based on a risk-adapted, dynamic subdivision of eligible KT patients in different risk categories (RC) with different protocol strategies (PS). Of 598 patients included in the study, 52 (9%) patients had hemodynamically significant TRAS and underwent percutaneous angioplasty (PTA) and stent placement. Technical and clinical success rates were 97% and 90%, respectively. 7 cases of restenosis were recorded at follow-up and treated with re-PTA plus stenting. Both DU imaging and clinical parameters improved after stent placement. Prospective high-quality studies are needed to test the efficacy and safety of our protocol in larger series. Accurate trial design and standardized reporting of patient outcomes will be key to address the current clinical needs

Robot-assisted kidney transplantation (RAKT) from living donors using right- versus left-sided grafts: Results from the EAU Robotic Urology Section (ERUS)-RAKT working group

Introduction & Objectives: RAKT from living donors (LD) is increasingly performed in selected centers with experience in robotic surgery and kidney transplantation (KT). Of note, KT from LD using right-sided graft (RSG) is challenging due to the brevity of the right renal vein and has been associated with a higher risk of perioperative complications in selected series. In this scenario, RAKT may facilitate the performance of vascular anastomoses in case of short renal vessels thanks to the advantages of the robotic platform. However, the evidence on the safety and feasibility of RAKT using RSGs is lacking. The aim of this study is to compare the surgical and early perioperative outcomes after RAKT from LD using right- vs. left-sided grafts in a large prospective multicenter cohort (ERUS-RAKT working group)

Robotic kidney transplantation using right-versus left-sided grafts from living donors: an european multicentre experience (ERUS-RAKT working group)

Introduction: RAKT from living donors (LD) is increasingly performedin selected centers with experience in robotic surgery and kidneytransplantation (KT). Of note, KT from LD using right-sided graft (RSG)is challenging due to the brevity of the right renal vein and has beenassociated with a higher riskof perioperative complications in selectedseries. In this scenario, RAKT may facilitate the performance ofvascular anastomoses in case of short renal vessels thanks to theadvantages of the robotic platform. However, the evidence on thesafety and feasibility of RAKT using RSGs is lacking. The aim of thisstudy is to compare the surgical andearly perioperative outcomes after RAKT from LD using right- vs. left-sided grafts in a large prospectivemulticenter cohort (ERUS-RAKT working group)